Thrombus formation in a dilated torcula following aneurysmal subarachnoid haemorrhage.

A case of thrombus formation occurring within a dilation of the dural venous sinuses following aneurysmal sub-arachnoid haemorrhage is presented. Acute neurological deterioration accompanied propagation of the thrombus. The patient was anticoagulated on day 5 post-SAH with no haemorrhagic complications and made a full recovery. The optimum time to commence anticoagulation is not clear and is discussed.

Clinical and neuroimaging features of severely brain-injured patients treated in a neurosurgical unit compared with patients treated in peripheral non-neurosurgical hospitals.

Most European TBI patients are managed in peripheral hospitals without benefit of guidelines for transfer of such patients to neurosurgical units as needed. This report compares clinical features and outcomes in two series of severe TBI patients: those admitted to a neurosurgical centre or to a general hospital, all in the Piedmont Region of Italy. Of 630 patients with a GCS of 3-8, 351 were admitted to a centralized neurosurgical unit, and 279 were admitted and treated at a peripheral hospital. All patients had a CT scan read by a neurosurgeon on duty and were classified using the Marshall criteria as having a diffuse injury or non-surgical mass lesions. Outcomes were assessed between 6 months and 6 years using either the GOS Extended or the GOS. Independent variables were age, sex, GCS score and Marshall classification. All the examined factors were significantly different between the two groups (p<0.001). For patients admitted to the neurosurgical centre, age, Marshall classification of the CT and GCS were predictors of a favourable outcome, while for patients treated in general hospitals, Marshall classification of the CT, gender and age were predictors of a favourable outcome. Patients admitted to neurosurgical centres are different from those treated in general hospitals not having these specialized facilities and personnel. The absence of guidelines for the transfer of these patients for more advanced care are lacking and should be the focus of new studies on patient referral.

[Anti-pseudomonas-specific precipitins as a marker of chronic infection in patients with cystic fibrosis]. / Le precipitine specifiche antipseudomonas come marker di infezione cronica nel paziente fibrocistico.

AIMS: The authors underline the characteristics of Pseudomonas aeruginosa and its methods of action on bronchial mucosa in cystic fibrosis. They then discuss the two concepts of "colonisation" and "chronic infection". METHODS: The level of "infection" was evaluated using an immunoelectrophoretic method involving the precipitation of bands of specific precipitins. A technical description of the method is included. The authors illustrate the use of the method in 78 cases of cystic fibrosis, comparing the positive results obtained using precipitin electrophoresis with the results of direct bacteriological findings. RESULTS: Using the bacteriological criteria, a total of 26.9% of patients were diagnosed as infected, whereas this percentage rose to 32.1% using precipitins. 87.2% of cases were concordant using both methods. CONCLUSIONS: As a practical solution, the authors recommend that the two methods are combined, thus obtaining a marked reduction in the number of false positives with obvious consequences in terms of therapeutic decisions.

[The sweat test. The proposal to revise the concept of the "grey zone"]. / Il test del sudore. Una proposta di revisione del concetto di "zona grigia".

The results of the sweat tests performed in Turin CF Centre in the last four years were reviewed. The opportunity of changing the range of doubt, commonly situated between 40 and 70 mEq/l Cl-, has been considered. The sweat test appears worth to be repeated only for values > 60, unless clinical signs and symptoms persist.

[Diagnostic considerations on sinusitis in childhood]. / Considerazioni diagnostiche sulla sinusite in età pediatrica.

The presence of a radiographic sinusal opacification without any other clinical sign or symptom cannot lead to the diagnosis of "Sinusitis", if considered alone. In a previous paper we observed a high prevalence of patients with both clinical and radiographic signs of sinusitis and a high prevalence of neutrophils in the nasal secretions, now we tried to discover which clinical signs and symptoms are more likely to indicate an acute sinusitis. We compared cough, headache, bacteriological culture of nasal secretions with a sinusal CT scan, without finding any relationship. On the contrary, neutrophils in the nasal secretions and Rx are strictly inter-related with CT scan, with a sensitivity of 77% and a specificity of 100%.

[Study of IGG subgroups as prognosis markers in cystic fibrosis]. / Studio delle sottoclassi IgG come markers prognostici nella fibrosi cistica.

Pressler et al. (1988) showed a correlation between elevated serum levels of IgG2 and IgG3 with decreased lung function. We tried to verify that hypothesis and to evaluate the usefulness of IgG subclasses as prognostic markers in 54 cystic fibrosis patients. The serum levels of the IgG subclasses were determined by radial immunodiffusion and correlated to Vital capacity (VC), obtained with a bell spirometer (Biomedin), and to oxyhemoglobin saturation (SaO2), obtained with a pulse oximeter (Minolta Pulsox 7). For statistical analysis, Student's "t" test, Pearson's chi-square and multiple regression were used. Significance was accepted at p < 0.05. We found significant correlation between elevated serum levels of IgG1 and decreased VC (r = -0.53; p < 0.01), and between high levels of IgG1 and decreased SaO2 (r = -0.45; p < 0.01). Elevated serum levels of IgG1 are significantly correlated with high levels of IgG2 (r = 0.41; p < 0.05) and with high levels of IgG4 (r = 0.43; p < 0.05). There is significant correlation between the increase in IgG4 and SaO2 impairment (r = 0.51; p < 0.01), but no significant correlation between IgG4 and VC was found. Patients with elevated serum levels of IgG1 had significantly lower VC than patients with IgG1 below the normal range (p < 0.002). No difference in VC was found, when comparing patients with low and high levels of the other subclasses.(ABSTRACT TRUNCATED AT 250 WORDS)

Therapeutical doses of salbutamol inhibit the somatotropic responsiveness to growth hormone-releasing hormone in asthmatic children.

In humans beta-adrenergic receptors mediate an inhibitory effect on somatotropic function, likely via stimulation of hypothalamic somatostatin release. Accordingly, salbutamol (SAL), a beta 2-agonist, given iv abolishes the GH response to GH-releasing hormone (GHRH) in adults. Taking into account that in bronchial asthma an alteration in the beta-adrenergic neural control of airways has been hypothesized, we aimed to verify whether, in asthmatic children, beta-adrenergic activation inhibits or not GH secretion. To this goal, we studied the effect of therapeutical doses of SAL on GH response to GHRH in 15 asthmatic children (12 M and 3 F, 5.9-11.1 yr, pubertal stage I-II). All children underwent a GHRH test (1 microgram/kg iv). Moreover, in 7 children (group A), SAL was administered orally (0.125 mg/kg) 1 h before GHRH, while in 8 (group B) by inhaled aerosol (2 mg) 30 min before GHRH. Oral SAL (group A) abolished the GHRH-induced GH rise (AUC, mean +/- SE 165.1 +/- 33.3 vs 959.9 +/- 158.1 micrograms/L/h; p < 0.03). In group B, the GH response to GHRH was only blunted by inhaled SAL (938.6 +/- 284.6 vs 1378.8 +/- 315.6 micrograms/L/h; p < 0.02). In conclusion, our data show that in asthmatic children, therapeutical doses of SAL exert a marked inhibitory effect on GH secretion. Further studies are needed to exclude detrimental effects of chronic treatment with beta 2-agonists on GH secretion and growth velocity in asthmatic children.

[Bronchography in children. Methodologic, statistical and functional findings]. / La broncografia in età pediatrica. Rilievi metodologici, statistici e funzionali.

The value of bronchography in the various respiratory diseases of childhood is examined. After a brief critical review of the historical development of bronchography, 10 cases encountered in the Pneumology Unit of Regina Margherita Children's Hospital, Turin are examined in order to compare the indications to and results of bronchography. In the light of the results obtained guidelines for the selection of bronchography as a diagnostic procedure are presented, specifying the situations in which stratigraphy, CAT scans or NMR are not adequate substitutes and suggesting what should be the current role of bronchography in paediatrics.